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sue served to good purpose generally throughout surgery, in the subject at hand more than these should be given consideration, because we were dealing with biology. It was not simply a matter of intestinal stasis. We must remember that the bowel might be matted into one mass 34S f'ROCI:i:f>l\GS Ol- ,S(H7/-.7//i.V. :ai. Jours by chronic peritonitis, so that great interference with peristalsis must exist, and still intestinal toxemia not be present. Not a few cases of acute intestinal obstruction, and many of these of Levothroid 100 Mg a chronic type, were not accompanied by toxemia. The matter of intestinal stasis, an important one in this connection, was far from being proved, and it should Levothroid Vs Synthroid always be lemembcred in medicine that the co- existence of two phenomena did not prove that they stood in the relation of cause and effect. .Adhesions took place in the pia mater, pleura, pericardium, and joint cavities only because of infection with bacteria, and the same was true of the peritoneal cavity. We did not have to Levothroid Vs Levothyroxine go as far back as congenital conditions or deep into the theory of toxemia to account for them, and in his opinion, all ad- hesions of the peritoneal cavity were directly bacterial in Purchase Levothroid Online nature. In this connection, it was not necessary to have ulceration or other pathological conditions of the gut to permit bacteria to pass outside of its lumen. It had been proved conclusively that bacteria could pass through a normal mucous membrane of the intestine, and. prac- tically, they often did so. The subject was bound up in the Levothroid 125 Mcg bacteriology of the intestines, and this was further shown by the fact that the upper part of the small intes- tine, where there were but few Generic Levothroid bacteria, was practically free from adhesions. Then, most of the adhesions were found in those parts of the intestines U'here the veins and lymphatics emerged, as. for instance, the anterior band of the colon. Lastly, Levothroid 0.1 Mg his studies had suggested that the bacteriology of the intestinal canal in adhesion cases was never normal. There were some ten forms of anaerobes of the bacilli class alone responsible for adhesions, not to mention the coccal and aerobic forms. Recently, he had isolated a new bacterium which was commonly present in the stools Levoxyl Vs Levothroid of cases where there w-ere marked adhesions and which, when grown in culture and thrown into the intestinal canal of dogs, would produce pericolonic adhe- sions after a few injections. .\s to splanchnoptosis being responsible for adhesions, he would take different ground and say that splanchnoptosis was due to intestinal toxemia, because in his studies of four autopsy cases of splanch- noptosis he had been able to prove that distinct degenera- tion of the sympathetic plexuses of the abdomen existed, this being about the same type of degeneration noted in some cases Levothroid Synthroid of myoma uteri. Thus he felt that a toxemia affected the neuromuscular Levothroid Generic structures of the stomach and intestines, and then the extrinsic nerves: making possible the production of dilatation of localized or generalized character. The splanchnics. as was known, were the in- hibitory influences of the hollow viscera of the abdomen. Thus, Levothroid 25 Mcg with the toxemia Order Levothroid Online persisting, degeneration took place in the sympathetic system of the abdomen, and then pro- lapse ensued by reason of the disturbing effects ^n the nutrition of the abdomen as a whole. Adhesions might ensue, as the final result of the to.xemia. plus Is Levothroid Generic bacterial extravasation. Dr. W.-VRD J. M.\c\e.\l said that peritoneal adhesion^ were either fibrinous or fibrous. The former were very temporary, and either disappeared or became organized into fibrous adhesions. The fibrinous adhesion was pro- duced by a general peritonitis or by a localized injury to the peritoneum. It was diflicult to conceive of such local- ized injury occurring as a result of the penetration of soluble bacterial Levothroid 88 Mcg toxines through an intact intestinal wall, and it would seem that the local injury was most fre- quently caused by a localized infection of the suljserous tissues or by bacterial invasion of the serosa itself. The injury to the serous coat brought about a ■ precipitation of fibrin which served as a weak bond of union to somt contiguous structure. If this fibrous union organizeii into fibrous tissue, a typical firm adhesion was the result. It was the latter type with which the physician and the sur- geon had to deal. Such a fibrous adhesion was of the same order as a scar, and it might be impossible to arrive at any reliable conclusion as to the original etiological factors by the examination of such a scar. In order to study the etiology of peritoneal adhesions resort might best be had to experimental surgery, to ascertain the e.xact conditions which determined the production of adhesions and to distinguish them from the circumstances Order Levothroid under which the form.ation of adhesions did not occur. A series of careful observations along this line had recently been reported by Adams in his Hunterian lecture before the Royal College of Surgeons (Lancet, March 8. T9131. He had been able to produce both infected and bacteria free adhesions in the peritoneal cavities of guineapigs and rab- bits. Noninfective adhesions were induced by destructive injury to the peritoneum, but with greater certainty by the introduction of foreign bodies (such as cotton sponges and Levothyroxine Vs Levothroid drainage tubes) into the peritoneal cavity. Often these adhesions would subsequently become Synthroid Vs Levothroid infected by the penetration of bacteria from the lumen of the intes- tine. Extravasated blood in the peritoneal cavity rarely caused adhesions unless it had become infected. Infec- tion of the peritoneum, and especially the introduction of infected foreign bodies, proved to be a ready method of causing adhesions. The omentum. Doctor MacNeal said, was one of the structures which most readily became adherent to an area of injured iieritoneum. This was in part due to its wide range of excursion, and in part to the rapidity of absorption of foreign material by the lymphatics of the omentum. The movements of the omen- tum were wholly passive, and depended upon Levothroid 100 Mcg the active movements of other structures, the most important of such movements being intestinal peristalsis. Dr. Robert Colem.xx Kemp Levothroid 75 Mg said that the so called attic of the abdomen he believed to be of great importance from a pathological standpoint, and it was Doctor Morris who first called our attention to the fact that the "spider web'' adhesions emanating from the diseased gallbladder, and involving the pylorus or upper duodenum, produced dilatation of the stomach, and at times even hemorrhage

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